Browsing by Author "Kovarik, Carrie L"
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- ItemThe accuracy of mobile teleradiology in the evaluation of chest X-rays.(2014-12-10) Schwartz, Adam B; Siddiqui, Gina; Barbieri, John S; Akhtar, Amana L; Kim, Woojin; Littman-Quinn, Ryan; Conant, Emily F; Gupta, Narainder K; Pukenas, Bryan A; Ramchandani, Parvati; Lev-Toaff, Anna S; Tobey, Jennifer D; Torigian, Drew A; Praestgaard, Amy H; Kovarik, Carrie LWe assessed the diagnostic accuracy of digital photographs of plain film chest X rays CXRs obtained using a mobile phone The study was a randomized non inferiority trial in which physical plain film CXRs viewed on a light box were compared with digital photographs of plain film CXRs CXRs were selected from a database of radiology studies to show common pathologies found in Botswana associated with pneumonia lung carcinoma tuberculosis pneumothorax and interstitial disease as well as normal findings The pre selected diagnoses were subsequently verified by a second radiologist Seven radiologists were randomized to review 75 plain film CXRs on light boxes before viewing 75 digital photographs or vice versa Their responses were considered correct if they matched the pre defined diagnosis For both modalities the correct diagnosis was provided in 79 of cases for plain film CXRs the correct diagnosis was provided in 82 of cases and for digital photographs the correct diagnosis was provided in 76 of cases The difference in diagnostic accuracy was 5 7 95 CI 10 8 to 0 5 which confirmed non inferiority PUnder0 001 for the primary outcome of diagnostic accuracy A subgroup analysis demonstrated non inferiority for lung carcinoma and pneumonia images although non inferiority was not achieved for pneumothorax tuberculosis interstitial disease or normal images The study demonstrates that digital photographs of CXRs obtained via a mobile phone equipped with a digital camera are non inferior to plain film CXRs
- ItemApplication of mobile teledermatology for skin cancer screening.(2012-09-17) Lamel, Sonia A; Haldeman, Kristin M; Ely, Haines; Kovarik, Carrie L; Pak, Hon; Armstrong, April WBACKGROUND With advancements in mobile technology cellular phone based store and forward teledermatology may be applied to skin cancer screening OBJECTIVE We sought to determine diagnostic and management concordance between in person and teledermatology evaluations for patients at skin cancer screening whose clinical images and history were transmitted through mobile phones METHODS A total of 86 patients with 137 skin lesions presented to a skin cancer screening event in California These patients clinical history and skin images were captured by a software enabled mobile phone Patients were assessed separately by an in person dermatologist and a teledermatologist who evaluated the mobile phone transmitted history and images Diagnostic and management concordance was determined between the in person and teledermatology evaluations RESULTS The primary categorical diagnostic concordance was 82 between the in person dermatologist and the teledermatologist 95 confidence interval 0 73 0 89 with a Kappa coefficient of 0 62 indicating good agreement The aggregated diagnostic concordance between the in person dermatologist and the teledermatologist was 62 95 confidence interval 0 51 0 71 with Kappa coefficient of 0 60 indicating good agreement Management concordance between the in person dermatologist and the teledermatologist was 81 95 confidence interval 0 72 0 88 with a Kappa coefficient of 0 57 which indicates moderate agreement between the dermatologists Multivariate analysis showed that older age and presentation of atypical nevus were significantly associated with disagreement in diagnosis between the teledermatologist and in person dermatologist after adjusting for other factors LIMITATIONS Dermatoscopic images were not captured via mobile phones which might improve diagnostic accuracy CONCLUSION Mobile teledermatology using cellular phones is an innovative and convenient modality of providing dermatologic consultations for skin cancer screening
- ItemCost Analysis of a Store and Forward Teledermatology Consult System in Philadelphia.(0000-00-00) Yang, Xiaoshi; Barbieri, John S; Kovarik, Carrie LBACKGROUND Store and forward SAF teledermatology TD has the potential to increase access to timely high quality care for underserved populations However the cost effectiveness of TD for underserved populations is uncertain OBJECTIVE This study evaluates the potential cost savings associated with a SAF TD program implemented for an underserved population in the city health clinics of urban Philadelphia METHODS We performed a retrospective analysis of SAF TD consultations for 700 outpatients managed in 12 Philadelphia primary care clinics Primary care providers PCPs were asked to specify a treatment plan as well as the type of care for the patient in the absence of the TD service Analysis compared cost of each patient case using the TD consult model versus conventional care RESULTS Twenty seven percent 189 700 of in person dermatology clinic visits and 3 29 23 700 of emergency room ER visits were avoided using TD Compared to conventional care mean expected cost savings were 10 00 52 65 per TD consult In sensitivity analyses these estimated savings remained positive across a range of parameters LIMITATIONS The cost analysis relies on several assumptions regarding the cost of care and indirect costs were not included CONCLUSION Teledermatology can be a cost saving model while increasing access to dermatologic care
- ItemEstablishing telepathology in Africa: lessons from Botswana.(2011-04-18) Fischer, Max K; Kayembe, Mukendi K; Scheer, Arnold J; Introcaso, Camille E; Binder, Scott W; Kovarik, Carrie L
- ItemEvaluation of generic medical information accessed via mobile phones at the point of care in resource-limited settings.(2013-12-16) Goldbach, Hayley; Chang, Aileen Y; Kyer, Andrea; Ketshogileng, Dineo; Taylor, Lynne; Chandra, Amit; Dacso, Matthew; Kung, Shiang-Ju; Rijken, Taatske; Fontelo, Paul; Littman-Quinn, Ryan; Seymour, Anne K; Kovarik, Carrie LOBJECTIVE Many mobile phone resources have been developed to increase access to health education in the developing world yet few studies have compared these resources or quantified their performance in a resource limited setting This study aims to compare the performance of resident physicians in answering clinical scenarios using PubMed abstracts accessed via the PubMed for Handhelds PubMed4Hh website versus medical drug reference applications Medical Apps accessed via software on the mobile phone METHODS A two arm comparative study with crossover design was conducted Subjects who were resident physicians at the University of Botswana completed eight scenarios each with multi part questions The primary outcome was a grade for each question The primary independent variable was the intervention arm and other independent variables included residency and question RESULTS Within each question type there were significant differences in percentage correct between Medical Apps and PubMed4Hh for three of the six types of questions drug related diagnosis definitions and treatment management Within each of these question types Medical Apps had a higher percentage of fully correct responses than PubMed4Hh 63 vs 13 33 vs 12 and 41 vs 13 respectively PubMed4Hh performed better for epidemiologic questions CONCLUSIONS While mobile access to primary literature remains important and serves an information niche mobile applications with condensed content may be more appropriate for point of care information needs Further research is required to examine the specific information needs of clinicians in resource limited settings and to evaluate the appropriateness of current resources in bridging location and context specific information gaps
- ItemImplementation of m-health applications in Botswana: telemedicine and education on mobile devices in a low resource setting.(2013-05-22) Littman-Quinn, Ryan; Mibenge, Chikoti; Antwi, Cynthia; Chandra, Amit; Kovarik, Carrie LAlthough Botswana has recently been categorised as an upper middle income country it is burdened by a scarcity of resources both human and technological There are barriers to patients access to specialized care and healthcare providers access to medical knowledge Over the past three years the Botswana University of Pennsylvania Partnership BUP has piloted four mobile telemedicine projects in the specialties of women s health cervical cancer screening utilizing visual inspection with acetic acid radiology oral medicine and dermatology Mobile telemedicine has been used in 11 locations in Botswana training a total of 24 clinicians and successfully contributing to the management of 643 cases In addition to mobile telemedicine BUP has initiated an m learning programme with the University of Botswana School of Medicine While successfully providing patients and providers with improved access to healthcare resources the m health projects have faced numerous technical and social challenges These include malfunctioning mobile devices unreliable IT infrastructure accidental damage to mobile devices and cultural misalignment between IT and healthcare providers BUP has worked with its local partners to develop solutions to these problems To ensure sustainability m health programmes must have strategic goals that are aligned with those of the national health and education system and the initiatives must be owned and led by local stakeholders Whenever possible open source technology and local IT expertise and infrastructure should be employed
- ItemA mobile health approach to tuberculosis contact tracing in resource-limited settings.(2013-08-07) Ha, Yoonhee P; Littman-Quinn, Ryan; Antwi, Cynthia; Seropola, Gorewang; Green, Rebecca S; Tesfalul, Martha A; Ho-Foster, Ari; Luberti, Anthony A; Holmes, John H; Steenhoff, Andrew P; Kovarik, Carrie LTuberculosis remains a leading cause of morbidity and mortality worldwide In 2011 there were 8 7 million new cases and 1 4 million deaths from the disease with Andgt 95 of these deaths taking place in low and middle income countries 1 Contact tracing prevents the spread of tuberculosis by identifying and screening a case s contacts and referring symptomatic individuals to health care providers Traditionally contact tracing has been conducted with paper forms which can lead to considerable inefficiencies in data collection storage and retrieval These inefficiencies are problematic as tuberculosis can continue to spread if disruption of disease transmission is delayed Mobile health approaches to tuberculosis contact tracing remain largely unaddressed and limited to management and monitoring of multidrug resistant tuberculosis 2 To address these limitations a mobile health application that digitizes and automates contact tracing was developed This poster presents work currently underway to evaluate this new approach in Botswana which has the tenth highest incidence rate of tuberculosis in the world 3 Operational considerations for implementing a mobile health approach to contact tracing in resource limited settings are also presented
- ItemReliability and validity of mobile teledermatology in human immunodeficiency virus-positive patients in Botswana: a pilot study.(2014-06-12) Azfar, Rahat S; Lee, Robert A; Castelo-Soccio, Leslie; Greenberg, Martin S; Bilker, Warren B; Gelfand, Joel M; Kovarik, Carrie LMobile teledermatology may increase access to care
- ItemThe reliability of teledermatology to triage inpatient dermatology consultations.(2014-04-10) Barbieri, John S; Nelson, Caroline A; James, William D; Margolis, David J; Littman-Quinn, Ryan; Kovarik, Carrie L; Rosenbach, MishaMany hospitals do not have inpatient dermatologic consultative services and most have reduced availability of services during off hours Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency thereby expanding access to specialized care for hospitalized patients
- ItemRobotic teledermatopathology from an African dermatology clinic.(2014-04-18) Micheletti, Robert G; Steele, Katherine T; Kovarik, Carrie L
- ItemThe role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the African Teledermatology Project.(2011-01-19) Tsang, Matthew W; Kovarik, Carrie LAccess to dermatology and dermatopathology services is scarce in sub Saharan Africa Teledermatology provides consultations for healthcare providers in resource limited settings where specialty medical services are difficult to obtain and the African Teledermatology Project has helped to bridge the gap in dermatological care in Africa This program also allows for biopsy specimens to be sent to the USA for processing in cases where the clinical diagnosis is difficult and definitive diagnosis has implications for patient management This study characterizes conditions diagnosed through clinicopathological correlation in conjunction with photos and tissue submitted to the African Teledermatology Project
- ItemScaling up a Mobile Telemedicine Solution in Botswana: Keys to Sustainability.(2015-01-08) Ndlovu, Kagiso; Littman-Quinn, Ryan; Park, Elizabeth; Dikai, Zambo; Kovarik, Carrie LEffective health care delivery is significantly compromised in an environment where resources both human and technical are limited Botswana s health care system is one of the many in the African continent with few specialized medical doctors thereby posing a barrier to patients access to health care services In addition the traditional landline and non robust Information Technology IT network infrastructure characterized by slow bandwidth still dominates the health care system in Botswana Upgrading of the landline IT infrastructure to meet today s health care demands is a tedious long and expensive process Despite these challenges there still lies hope in health care delivery utilizing wireless telecommunication services Botswana has recently experienced tremendous growth in the mobile telecommunication industry coupled with an increase in the number of individually owned mobile devices This growth inspired the Botswana UPenn Partnership BUP to collaborate with local partners to explore using mobile devices as tools to improve access to specialized health care delivery Pilot studies were conducted across four medical specialties including radiology oral medicine dermatology and cervical cancer screening Findings from the studies became vital evidence in support of the first scale up project of a mobile telemedicine solution in Botswana also known as Kgonafalo Some technical and social challenges were encountered during the initial studies such as malfunctioning of mobile devices accidental damage of devices and cultural misalignment between IT and healthcare providers These challenges brought about lessons learnt including a strong need for unwavering senior management support establishment of solid local public private partnerships and efficient project sustainability plans Sustainability milestones included the development and signing of a Memorandum of Understanding MOU between the Botswana government and a private telecommunications partner the publication and awarding of the government tender to a local IT company and the development and signing of a Memorandum of Agreement between the Ministry of Health Clinical Services department and the local tender winner The initial system scale up is scheduled to occur in 2014 and to ensure the project s sustainability the system is aligned with the national eHealth strategy and local ownership of the project remains at the forefront 1
- ItemTeledermatologic care, the Affordable Care Act, and 20 million new patients: picturing the future.(2014-03-13) Rubin, Courtney B; Kovarik, Carrie L
- ItemTelemedicine Use in International Relief Efforts.(2014-12-10) Asemota, Eseosa; Kovarik, Carrie L
- ItemUse of mobile learning by resident physicians in Botswana.(2012-02-03) Chang, Aileen Y; Ghose, Sankalpo; Littman-Quinn, Ryan; Anolik, Rachel B; Kyer, Andrea; Mazhani, Loeto; Seymour, Anne K; Kovarik, Carrie LWith the growth of mobile health in recent years learning through the use of mobile devices mobile learning mLearning has gained recognition as a potential method for increasing healthcare providers access to medical information and resources in resource limited settings In partnership with the University of Botswana School of Medicine SOM we have been exploring the role of smartphone based mLearning with resident physicians in specialty training education The SOM which admitted its first class of medical students and residents in 2009 is committed to providing high level on site educational resources for resident physicians even when practicing in remote locations Seven residents were trained to use an Android based myTouch 3G smartphone equipped with data enabled subscriber identity module SIM cards and built in camera Phones contained locally loaded point of care and drug information applications a telemedicine application that allows for the submission of cases to local mentors and e mail Web access Surveys were administered at 4 weeks and 8 weeks following distribution of phones We found that smartphones loaded with point of care tools are effectively utilized by resident physicians in resource limited settings both for accessing point of care medical information at the bedside and engaging in self directed learning at home
- ItemUse of mobile telemedicine for cervical cancer screening.(2011-05-20) Quinley, Kelly E; Gormley, Rachel H; Ratcliffe, Sarah J; Shih, Ting; Szep, Zsofia; Steiner, Ann; Ramogola-Masire, Doreen; Kovarik, Carrie LVisual inspection of the cervix with application of 4 acetic acid VIA is an inexpensive alternative to cytology based screening in areas where resources are limited such as in many developing countries We have examined the diagnostic agreement between off site remote expert diagnosis using photographs of the cervix photographic inspection with acetic acid PIA and in person VIA The images for remote evaluation were taken with a mobile phone and transmitted by MMS The study population consisted of 95 HIV positive women in Gaborone Botswana An expert gynaecologist made a definitive positive or negative reading on the PIA results of 64 out of the 95 women whose PIA images were also read by the nurse midwives The remaining 31 PIA images were deemed insufficient in quality for a reading by the expert gynaecologist The positive nurse PIA readings were concordant with the positive expert PIA readings in 82 of cases and the negative PIA readings between the two groups were fully concordant in 89 of cases These results suggest that mobile telemedicine may be useful to improve access of women in remote areas to cervical cancer screening utilizing the VIA see and treat method